Winter skincare
As we enter the cool and crisp days of autumn, we can notice shifts in our body that mirror the overarching Vata influence in the air. This might look like feeling a little unsettled, experiencing bloating and constipation, noticing cracking joints or flare-ups of dry skin issues to name a few.
Dry, flaky and itchy skin complaints tend to go up in GP surgeries this time of year. Ayurveda would explain this as a Vata imbalance, and our modern times drive this up even more with indoor heating, fast-paced lifestyles, eating on the go and inadequate nourishment.
Like other health concerns, Ayurveda teaches us to look to the gut first along with lifestyle patterns for clues to why this imbalance is happening. It also teaches us that like increases like so opposites will tend to remedy.
While each case will be different as no two people are the same, there are some universal helpful habits that can ease the symptoms of dry, flaky and itchy skin, once it has been ruled out that this isn’t a caused by an infection or allergy.
Stay hydrated
Moisturise!
Take short and warm showers instead of long and hot showers
Eat good fats
Cut down or cut out sugar
Let’s look at these in a bit more detail.
Water – friend or foe?
Exposure to water in general is drying for the skin (1). The longer the time and the use of hot water makes this worse, damaging the skin’s barrier function (2). So, it’s better to take showers that are shorter and using lukewarm water rather than hot.
But, don’t scrimp on drinking water. Especially in the Winter months where we might not feel as thirsty, it’s important we keep up our water intake. Drinking adequate amounts of water is important for skin hydration and improves its elasticity (3) which tells us it’s barrier is strong.
The skin loves good fats
Lipids are an essential component of our cell structure and our skin has its own mix of lipids, sebum and cholesterol to protect it from drying out and from bacteria. Many common skin issues are due to an imbalance in the levels of fatty acids (lipids) in the skin. There is more focus on omega-3 and omega-6 fatty acids because these are essential, meaning that they are not produced by the body so we need to get them from our diet. However, our modern diet contains a high level of omega-6 fatty acids (processed seed oils) which create low-grade inflammation in the body (4). Reducing our consumption of omega-6 oils and increasing our omega-3 fatty acids will create a balance that has shown to be beneficial for our whole body (5).
Fatty fish (mackerel, trout, salmon, tuna, cod) are the best sources of omega-3 fatty acids because they contain the EPA and DHA type (essential for growth, brain health and reducing inflammation). Fish also contains zinc, an essential mineral for building and repairing skin tissue (6). DHA intake has been shown to improve eczema symptoms (7, 8). It is possible to get omega-3 from plant sources such as flaxseeds, walnuts and avocados too, but they only contain the ALA type which is not biologically active unless converted to DHA. This can be converted into EPA and DHA once inside the body but the conversion rate is very low (9, 10). For this reason, unless you are a vegetarian or just can’t stand it, try to make fish a part of your diet.
And don’t forget to moisturise from the outside too. Rather than using water-based creams that have a long list of ingredients you don’t recognise, go for cold-pressed oils. For dry, flaky and itchy skin, Ayurveda recommends sesame oil. This monounsaturated oil restores the hydrophilic layer and prevents skin from drying out. High in oleic acid (omega-9), it is soothing, anti-inflammatory and regenerating, improving the skin’s elasticity. It’s one of the few oils that contains vitamin K, known to help with wound healing (11), and it’s high in antioxidants, making it a stable oil that is not likely to oxidise easily. You can read more about the benefits of sesame oil here.
Kokum butter is another star ingredient for dry skin. It contains garcinol, a strong antioxidant. It’s free radical cleaning action is greater than that of vitamin E (12) and, by disrupting inflammatory pathways (13, 14, 15) kokum butter is ideal for soothing inflamed skin conditions. Kokum butter is particularly useful where skin is damaged as it has a glycation-inhibiting effect (16), and blocks the enzymes that break down elastin and hyaluronic acid (17). Considering it is a butter, kokum butter is an extremely moisturising yet lightweight and non-greasy ingredient, ideal for those with sensitive, dry and irritated skin.
Sugar accelerates ageing
Studies show that a diet high in simple sugars increases inflammatory messengers that are involved in psoriasis (18, 19). But, it also causes widespread inflammation in the body in various ways which compromises the skin.
Sugar disrupts the gut’s microbiome (bacterial environment) by preventing good bacteria from staying there and driving up pro-inflammatory bacteria (20). The good bacteria that it prevents from sticking around it key to protecting our gut lining. Without it, we can get leaky gut where toxins from our gut travel into the general circulation and we start seeing inflammation. Sugar also reduces the diversity in gut bacteria and research has shown that those with eczema have low diversity in gut bacteria (21, 22, 23) with some studies showing improvement in eczema after taking probiotics (24, 25). These studies on the role of probiotics are recent though and currently show conflicting results (26).
Through a process called glycation, sugar binds to proteins, stopping them from functioning properly and making them more reactive (oxidative stress) leading to damage. In relation to the skin, sugar does this to collagen and elastin (27). Both are important proteins needed for the structure of our skin. If affected, this can affect the skin’s ability to repair and cause wrinkles. If we already have a dry skin condition, this could impact the skin’s healing process.
The low-grade inflammation that our modern, sugar-laden diets create in our body leads to our fat cells releasing inflammatory markers. These inflammatory markers interfere with insulin signalling and our muscle, fat and liver cells stop responding as well to insulin. So, our body is left in a hyperglycaemic (high glucose) and pro-inflammatory state. In a healthy state, insulin helps control our blood glucose levels and is also anti-inflammatory (28) but with insulin resistance, we now see a cascade of inflammation in the body which is correlated with many conditions (type 2 diabetes, cardiovascular disease, PCOS, neurodegeneration) including skin conditions such as psoriasis (29, 30).
A high sugar diet also leads to inflammation of the liver (20). When the liver is not working optimally because of inflammation, it cannot carry out all its other important functions including detoxification and processing of nutrients and vitamins necessary for general and skin health. From an Ayurvedic perspective, there is a strong link between the liver and skin and any congestion in the liver (physiologically or emotionally induced), can lead to toxin build-up in our circulatory system which can present as skin disorders.
Gently does it
Because of the times we live in, with increased exposure to toxins, I want to add an extra tip:
Use gentle and fragrance-free soaps, shower gels and moisturisers
What do I mean by this? Many skincare products will contain ingredients that can be harmul for us (31). Not just irritating at a surface level but some can also effect our body at a deeper level.
What is SLS?
Sodium lauryl sulfate (SLS) is a detergent. This is an ingredient which makes our body washes and shampoos foamy. Its job is to have a cleansing action, stripping away oil. At first, this might sound great if you’re thinking along the lines that it will remove dirt and residue from the body and hair. But, SLSs have been shown to have damaging effects on the skin.
Moisturisers containing SLS impair the integrity of the skin barrier and provide less hydration (32). SLS has been found to reach deeper layers of the skin and has even been found to remain in the tissue seven days after using it topically on the skin (33). As well as disturbing the skin barrier and hydration, SLS has also been found to change the skin’s natural bacterial makeup (34), change the DNA structure of our skin cells (keratinocytes), reduce important skin protein (profillaggrin), and also change the activity of enzymes leading to a breakdown of coreneodesmosomes (35). These are important components that create a cohesive structure to the top layer of our skin.
A cream that was commonly prescribed for those experiencing eczema was Aqueous cream. Aqueous cream contains SLS which is used to emulsify the formulation into a cream consistency. However, several studies show that the use of Aqueous cream actually leads to a decrease in the number of surface level skin cells (corneocytes), thinning of the skin and reduced it’s barrier function, leading to water loss so the skin is less hydrated (36, 37, 38).
Today, most pharmacists and healthcare professionals tend to advise on using emollient creams (Cetraben, Zerocream, Epimax) instead. These on the whole do not contain SLS but do contain liquid parrafin. Liquid parrafin is a mineral oil (a derivative of petroleum) and is a known allergen.
Parabens
So that skincare products last long enough without going rancid, they need to be preserved. Parabens are preservatives that do just that. But they come with a whole host of side effects too.
Parabens mimic oestrogens and have been reported to disrupt our hormones (endocrine disruptors). With an excess of circulating oestrogen and a liver that is less capable of clearing away this excess because of overload from our modern diets, the extra oestrogen can lead to a number of health issues down the line. Studies show that cancerous breast tissue contains higher levels of parabens (39) and that parabens stimulate cancer growth (40, 41).
Fragrances
While fragrances can make products smell lovely, they are well-known skin irritants and sensitisers. Even natural essential oils can be highly volatile, leading to skin reactions. When fragrance allergens are mixed, they become more potent and can lead to stronger contact reactions (42).
That might all seem like a lot to think about, but remember that the skin is the only organ that interfaces directly with the outside world and so we need to consider both what we consume internally and apply externally. Taking a holistic approach to something that seems so ordinary as dry, itchy Winter skin, shows us how interconnected our body and environment are.
Useful resource:
EWG’s Skin Deep Database is an excellent guide to the ingredients in our skincare products. Just type in the ingredients and it gives you a definition, other names that the ingredient goes by, and a safety scoring.
References:
(1) Firooz et al., (2015)The effects of water exposure on biophysical properties of normal skin. Skin Research and Technology, 21(2)
(2) Herrero-Fernandez et al. (2022) Impact of water exposure and temperature changes on skin barrier function. Journal of Clinical Medicine, 11(2)
(3) Palma et al. (2015) Dietary water affects human skin hydration and biomechanics. Clinical, Cosmetic and Investigational Dermatology, 8
(4) Alzoghaibi et al. (2003) Linoleic acid, but no oleic acid, upregulates the production of interleukin-8 by human intestinal smooth muscle cells isolated from patients with Crohn’s disease. Clinical Nutrition, 22(6)
(5) DiNicolantonio and O’Keefe (2021) The importance of maintianing a low omega-6/omega-3 ration for reducing the risk of autoimmune diseases, asthma and allergies. Missouri Medicine, 11(5)
(6) Ogawa et al. (2018) Zinc and skin disorders. Nutrients, 10(2)
(7) Jia et al. (2019) Treatment with Decosahexaenoic acid improves epidermal keratinocyte differentiation and ameliorates inflammation in human keratinocytes and reconstructed human epidermis models. Molecules, 24(17)
(8) Koch et al. (2008) Decosahexaenoic acid (DHA) supplementation in atopic eczema: a randomised, double-blind, controlled trial. British Journal of Dermatology, 158(4)
(9) Brenna (2002) Efficiency of conversion of alpha-linoleic acid to long-chain n-3 fatty acids in main. Current Opinion in Clinical Nutrition and Metabolic Care, 5(2)
(10) Gerster (1998) Can adults adequately convert alpha-linoleic acid (18:3n-3) to eicosapentaenoic acid (20:5n—3) and decosahexaenoic (22:6n-3)? International Journal for Vitamin and Nutrition Research, 68(3)
(11) Pazyar et al. (2019) Wound healing effects of topical vitamin K: a randomised controlled trial. Indian Journal of pharmacology, 51(2)
(12) Yamaguchi et al. (2000) Free radical scavenging activity and antinuclear activity of garcinol from Garcinia indica fruit rind. Journal of Agricultural and Food Chemistry, 48 (6)
(13) Hong et al. (2006) Modulation of arachidonic acid metabolism and nitric oxide synthesis by garcinol and its derivatives. Carcinogenesis, 27 (2)
(14) Liao et al. (2004) Suppression of inducible nitric oxide sunthase and cyclooxygenase-2 in downregulating nuclear factor-kappa B pathway by Garcinol. Molecular Carcinogenesis, 41 (3)
(15) Koeberle et al. (2009) Identification of 5-lipoxygenase and microsomal prostaglandin E2 synthase-1 as functional targets of the anti-inflammatory and anti-carcinogenic garcinol. Biochemical Pharmacology, 77 (9)
(16) Yamaguchi et al. (2000) Antioxidant and anti-glycation activity of garcinol from Garcinia indica fruit rind. Journal of Agricultural and Food Chemistry, 48 (2)
(17) Sahasrabudhe and Deodhar (2010) Anti-hyaluronidase, anti-elastase activity of Garcinia indica. International Journal of Botany, 6 (3)
(18) Shi et al. (2021) Short-term Western diet intake promotes IL-23 mediated skin and joint inflammation accompanied by changes to the gut microbiota in mice. Journal of Investigative Dermatology, 141(7)
(19) Kanda et al. (2020) Nutrition and psoriasis. International Journal of Molecular Sciences, 21(15)
(20) Do et al. (2018) High glucose or fructose diet cause changes of the gut microbiota and metabolic disorders in mice without body weight change. Nutrients, 10(6)
(21) Abrahamsson et al. (2012) Low diversity of the gut microbiota in infants with atopic eczema. The Journal of Allergy and Clinical Immunology, 129(2)
(22) Forno et al. (2008) Diversity of the gut microbiota and eczema in early life. Clinical and Molecular Allergy, 6
(23) Ismail et al. (2012) Reduced gut microbial diversity in early life is associated with later development of eczema but not atopy in high-risk infants. Paediatric Allergy and Immunology, 23(7)
(24) Huang et al. (2017) Probiotics for the treatment of atopic dermatitis in children: a systematic review and meta-analysis of randomised controlled trials. Frontiers in Cellular and Infection Microbiology, 7
(25) Jung et al. (2019) Lysates of a probiotic, Lactobacillus rhamnosus, can improve skin barrier function in a reconstructed human epidermis model. International Journal of Molecular Sciences, 20(17)
(26) Lu et al. (2018) Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomised controlled trials. BMC Complementary Medicine and Therapies, 18
(27) Nguyen and Katta (2015) Sugar sag: glycation and the role of diet in skin ageing. Skin Therapy Letter, 20(6). Available at: https://www.skintherapyletter.com/aging-skin/glycation/
(28) Sun et al. (2014) New insights into insulin: the anti-inflammatory effect and its clinical relevance. World Journal of Diabetes, 5(2)
(29) Boehncke et al. (2007) Psoriasis patients show signs of insulin resistance. British Journal of Dermatology, 157(6)
(30) Rajappa et al. (2015) Effect of treatment with methotrexate and coal tar on adipokine levels and indices of insulin resistance and sensitivity in patients with psoriasis vulgaris. Journal of European Academy of Dermatology and Venereology, 29(1)
(31) Panico et al. (2019) Skin safety and health prevention: an overview of chemimcals in cosmetic products. Journal of Preventive Medicine and Hygiene, 60(1)
(32) Chan et el. (2019) Comparison of irritancy potential of sodium lauryl sulfate-free aqueous cream to other moisturisers: an intraindividual skin occlusive study. The Journal of Clinical and Aesthetic Dermatology, 12(7)
(33) Patil et al. (1995) Quantification of sodium lauryl sulfate penetration into the skin and underlying tissue after topical application – pharmacological and toxicological implications. Journal of Pharmaceutical Sciences, 84(10)
(34) Leoty-Okombi et al. (2021) Effect of sodium lauryl sulfate (SLS) applied as a patch on human skin physiology and its microbiota. Cosmetics 8(6)
(35) Torma et al. (2007) Skin barrier disruption by sodium lauryl sulfate-exposure alters the expressions of involucrin, transglutaminase 1, profilaggrin, and kallikreins during the repair phase in human skin in vivo. Journal of Investigative Dermatology, 128(5)
(36) Danby et al. (2011) The effect of Aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis. British Journal of Dermatology, 165(2)
(37) Mohammed et al. (2011) Influence of Aqueous cream BP on corneocyte size, maturity, skin protease activity, protein content and transepidermal water loss. British Journal of Dermatology, 164(6)
(38) Tsang and Guy (2010) The effect of Aqueous cream BP on human stratum corneum in vivo. British Journal of Dermatology, 163(5)
(39) Downs et al. (2023) Parabens preferentially accumulate in metastatic breast tumors compared to benign breast tumors and the association of breast cancer risk factors with paraben accumulation. Environmental Advances, 11
(40) Dairkee et al. (2023) Reduction of daily-use parabens and phthalates reverse accumulation of cancer-associated phenotypes with disease-free breast tissue of study subjects. Chemosphere, 322
(41) Hager et al. (2022) Minireview: Parabens exposure and breast cancer. International Journal of Environmental Research and Public Health, 19(3)
(42) Bonefeld et al. (2011) Enhanced sensitisation and elicitation responses caused by mixtures of common fragrance allergens. Contact Dermatitis, 65(6)